Use of collagen for endoscopic correction in complicated vesicoureteral reflux

Abstract

Endoscopic treatment of children with primary vesicoureteral reflux (VUR) has become an alternative to long-term antibiotic prophylaxis and open surgery. The purpose of this study was to assess the efficiency and safety of endoscopic subureteral injections of collagen (STING) as a treatment for complicated VUR in children. Twenty-five patients (41 ureteral units) underwent a modified STING procedure for the correction of complicated VUR. Of these patients, five (nine refluxing units) had Hutch's diverticulum, 10 (17 refluxing units) had a duplex system, eight (10 refluxing units) had ureterocele, one (three refluxing units) had a unilateral triple ureter and one (two refluxing units) had a bilateral single ectopic ureter. Of these 41 ureteral units, 14 had grade III VUR, 17 grade IV and 10 grade V. Fourteen refluxing units (30%) received one session of STING, which was successful, and 27 (70%) needed a second session. A follow-up voiding cystourethrogram was performed 3 months after each session of STING. The mean follow-up period was 24 months (range 3-36 months). Of these 41 refluxing units, 34 were treated successfully and regression or downgrading occurred in seven. Follow-up i.v. pyelography or sonography did not reveal any urinary tract obstruction. The results of this study showed that endoscopic correction of these complicated refluxing ureters may be the first choice of treatment, but the technique must be modified to suit each individual case.